By Michael McAuliff
Doctors are urging Congress to call off cuts scheduled to take effect on Jan. 1 in the reimbursements they receive from Medicare.
In what has become an almost yearly ritual, physician groups are arguing that patients will have greater difficulty finding doctors who accept Medicare if lawmakers allow the pay cuts to happen.
A more than 4,000-page draft government spending bill released by lawmakers early Tuesday morning proposed much smaller-than-planned cuts to Medicare payments. But the bill, which Congress hoped to pass by the weekend to keep the government funded and avert a shutdown, would not go as far as doctors wanted.
“Despite overwhelming bipartisan, bicameral support to stop the full Medicare physician payment cut, Congress failed once again to end the cycle of harmful Medicare cuts, showing a disregard for vulnerable seniors,” the Surgical Care Coalition, an organization representing surgeons and anesthesiologists, said in a statement.
The doctors’ lobbying campaign had gained traction on Capitol Hill. A bipartisan group of 115 House lawmakers rallied behind doctors in a letter to congressional leaders and President Joe Biden last week, urging them to prevent cuts that they argued would “only make a bad situation far worse” for Medicare patients.
In recent years, the Centers for Medicare & Medicaid Services scheduled the pay cuts to offset the cost of increasing payments for underpaid services, like primary care. Physicians also stand to see reductions tied to broad cuts implemented by Congress in recent decades to try to control government spending.
Some Republicans have pushed to wait on passing the spending package until their party controls the House of Representatives next year and can have a greater say over what they call out-of-control spending. One priority of the incoming House Republican majority is curbing Social Security and Medicare, a federal health insurance program for people age 65 and older, among others.
“We’re mortgaging our kids’ futures,” Sen. Ron Johnson of Wisconsin, a Republican on the Senate Budget Committee, told reporters, referring to overall spending. “This is killing us from a financial standpoint. It’s got to stop.”
Despite concerns about ballooning government spending, for years doctors have been successful in delaying or softening proposed pay cuts, arguing that there would be dire consequences if the cuts kicked in.
Physicians carry a lot of political weight in Washington. The American Medical Association, the professional organization that represents and lobbies on behalf of physicians, has spent more than $460 million on lobbying since 1998, more than almost any other organization, The New Yorker reported this year.
Since the early 2000s, Congress has voted every year or two to delay or reverse plans to reduce Medicare payments to doctors. In 2015, Congress ended one measure that would have cut payments by 21%. Last year, Congress plugged a 3% hole.
If Congress is unable to pass the spending bill, physicians face a 4.5% cut in Medicare fees. Under the draft legislation released Tuesday, they would instead see about a 2% cut beginning Jan. 1. Other reductions — including a 4% cut under a congressional budget rule that balances spending and the expiration of a payment program that offered 5% bonuses — would be delayed further or reduced.
As in previous years, physicians have waged a frantic campaign to convince Congress that reducing the amount paid to care for Medicare patients would drive more doctors away from accepting them as patients at all.
Earlier this month, the American Medical Association sent a letter to congressional leaders signed by all 50 state medical associations, as well as that of the District of Columbia, arguing pay cuts would take a toll on doctors and patients.
“Burnout, stress, workload, and the cumulative impact of COVID-19 are leading one in five physicians to consider leaving their current practice within two years,” the letter said. “Payment cuts will only accelerate this unsustainable trend and undoubtedly lead to Medicare patients struggling to access health care services.”
According to the American Medical Association, the costs of running a medical practice climbed 39% from 2001 to 2021, but Medicare payments to doctors, adjusted for inflation, dropped by 20% over that span.
“Running our businesses is more expensive than it was,” said Dr. Loralie Ma, a radiologist in the Baltimore suburbs, citing rising costs for expenses ranging from gauze and surgical tubing to salaries for office staff. “It’s very hard, and when Medicare does something like this, it decreases access, specifically for seniors.”
“There are patients looking for physicians they can’t get. They’re on Medicare, and physicians aren’t accepting new Medicare patients,” said Dr. Donaldo Hernandez, a physician based in Santa Cruz, California, who is president of the California Medical Association.
It is difficult to “break even” caring for Medicare patients under the current government rates, he said. “It just doesn’t make economic sense.”
An agency that advises Congress on Medicare matters has expressed concern about certain Medicare payments for primary care and has reported that, from 2015 through 2020, the number of primary care physicians treating Medicare beneficiaries dropped from 2.8 to 2.4 per 1,000 beneficiaries.
According to the Medicare Payment Advisory Commission (MedPAC), about 3% of Medicare beneficiaries surveyed in 2021 said they had looked for a new primary care provider in the previous year and had trouble finding one.
However, looking at a broader picture based on data from 2019 through 2021, “access to clinician services for Medicare beneficiaries appeared stable and comparable to (or better than) that for privately insured individuals,” MedPAC Chair Michael Chernew said in an Oct. 28 letter to members of Congress.
Gerard Anderson, a professor of health policy and management at Johns Hopkins University, said doctors’ objections to the scheduled pay cuts have a familiar ring.“
For 40 years I have heard providers argue that they will go out of business or not accept Medicare patients if … cuts go through,” Anderson said. “Medicare patients are still seeing their physicians, hospitals, and other providers 40 years later.”
For most doctors, fee-for-service payments from Medicare represent a small portion of their business, Anderson added. The rest can include payments from Medicare Advantage health plans, which have their own payment systems, and private insurers, he said.
Sen. Debbie Stabenow of Michigan, a top Senate Democrat, and Sen. John Barrasso of Wyoming, a top Senate Republican, in November wrote a letter signed by a bipartisan group of 44 other senators in November urging party leaders to block the looming cuts.
“We’d like very much to have a health package that would stop cuts and do some other policy changes that we need. It’s not agreed to yet, but I’d love to see it happen,” Stabenow said in an interview with KHN on Dec. 15.
Asked if she was optimistic, she said, “I think we have a reasonable chance.”
KHN Washington editor and correspondent David Hilzenrath contributed to this report.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation. (HN/KHN)